Dark Side of a Mountain: Culture & Ideology in Medicine (2014)

DARK SIDE
OF A
MOUNTAIN
VERONIKA VALDOVA

Copyright © 2014 Veronika Valdova
All rights reserved.
ISBN: 1468001132
ISBN-13: 978-1468001136

DEDICATION
The book is dedicated to all physicians and clinical research
professionals who do the right thing for the right reasons.

i
TABLE OF CONTENTS
I. THE CODE........................................................................................................1
THE BOOK OF LEVITICUS................................................................... 2
THE RIGHTFUL AND THE WICKED ..................................................9
THE GUIDE FOR THE PERPLEXED ....................................................11
II. THE BLACK DEATH ................................................................................... 16
THE JUSTINIAN PLAGUE ....................................................................18
Causes and conditions of the plague pandemic ...................................22
THE 1348 PLAGUE................................................................................ 26
Causes of the 1348 plague pandemic......................................................27
The 1348 plague pandemic......................................................................30
THE ROLE OF IDEOLOGY .................................................................. 31
FLAWED LIFE SCIENCE DOCTRINE AS THE CAUSE OF INABILITY
TO CONTAIN PLAGUE ...........................................................................31
III. MEDICAL OATHS......................................................................................40
THE CODE OF HAMMURABI.............................................................41
THE VADAYA'S OATH........................................................................ 43
HINDU PHYSICIAN’S OATH..............................................................44
THE HIPPOCRATIC OATH ................................................................ 45
THE OATH OF ASAPH & YOHANAN ................................................51
THE OATH OF SUN SIMIAO ............................................................. 53
THE OATH AND THE PRAYER OF MAIMONIDES ........................ 54
The Oath of Maimonides........................................................................55
The Prayer of Maimonides......................................................................55
THE JOURNEY OF A PHYSICIAN – THE OATH OF THE SCHOOL OF
ENJUIN .................................................................................................. 58
The Oath of the School of Enjuin ..........................................................58

ii
The Bushido Code ...................................................................................59
THOMAS PERCIVAL'S MEDICAL JURISPRUDENCE AND MEDICAL
ETHICS...................................................................................................74
Medical jurisprudence or the Code of Ethics and Institutes .............. 75
OATH OF THE MEDICAL SOCIETY OF NEW YORK......................78
ETHICAL CODE OF THE AMERICAN MEDICAL ASSOCIATION.79
Medicine during the Civil War ...............................................................81
PRUSSIA: ALBERT MOLL'S MEDICAL ETHICS............................... 86
IMPERIAL HEALTH COUNCIL ON MEDICAL EXPERIMENTATION
.................................................................................................................92
Circular of the Reich minister of the interior: guidelines for new
therapy and human experimentation, 1931:..........................................93
HITLER'S GESUNDHEIT......................................................................95
Implementation of eugenic laws legally binding for physicians in Nazi
Germany...................................................................................................96
WORLD MEDICAL ASSOCIATION – THE DECLARATION OF
GENEVA (1948) ...................................................................................106
INTERNATIONAL CODE OF MEDICAL ETHICS (1949) ...............108
THE LOUIS LASAGNA OATH............................................................110
SOVIET MEDICAL OATH...................................................................118
Practical implementation of Soviet Oath ............................................ 119
MEDICAL OATHS USED TODAY......................................................127
INDIAN MEDICAL OATHS ............................................................... 129
Oath of Indian Medical Association.....................................................132
IV. THE EUGENIC TRAIL ..............................................................................134
THE NOBLE CAUSE ............................................................................135
BACK TO THE TRIBE OF LEVI ..........................................................137
THE POWER OF BLOOD AND PEDIGREE..................................... 140
The Eugenic Melting Pot (Europe in Turmoil) ...................................143

iii
Darwin and his Followers ..................................................................... 147
Galton’s Hereditary Genius (1869).......................................................149
THE LOW END.................................................................................... 152
The Jukes (1874)......................................................................................152
The Quest for Causes of Crime ............................................................ 154
AMERICAN EUGENICS ......................................................................159
Sterilization laws in America................................................................ 163
Number of eugenic sterilizations carried out in the United States..166
Immigration quota as per the 1924 U.S. Immigration Bill.................166
Fertility rates in the U.S. during the Great Depression .....................169
The power of the Constitution.............................................................169
THE ULTIMATE EUGENICISTS .........................................................171
The Aryan Race....................................................................................... 171
Homo Sovieticus.....................................................................................173
V. LEGACY ...................................................................................................175
SCIENTIST'S MIND.............................................................................176
The Nuremberg Medical Cases.........................................................177
How the ends rationalize the means............................................... 179
Physicians as the driving force of Nazi policies .............................180
The chosen few.................................................................................. 182
BIBLIOGRAPHY ............................................................................................. 184

1
I. THE CODE
Medical profession has always been a special one. Unique social
status of doctors stemmed from the power they had over people’s
lives, for their ability to heal the wounded and to bring the sick back
to life; a status which was at times of hardship perceived as closer to
God than to ordinary human beings. This noble profession requires
many years of dedication to master the skills required to understand
and uplift human body. The profession also requires an oath which
goes back to the times of ancient Greece and which requires medical
practitioners newly accepted into the ranks to treat their patients
to their best knowledge and act in the interest of their patients. Some
oaths also include a clause on physician’s duty not to take into
account the patient’s social status. The uncomfortable truth that not
all patients can afford the same level of care does inevitably come up;
and in most societies both ancient and contemporary the poor
receive some level of solidarity from those who are better off,
although the extent of this solidarity can be very limited. Medical
profession and priesthood, professions so close that they sometimes
merged in one, compare to the keepers of gate to the underworld.
People enter the world and leave it in the presence of medical
professionals and priests, and expect them to provide assistance
at times of crises.

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THE BOOK OF LEVITICUS
Leviticus, the third book of the Bible, is divided into 27 chapters
in which offerings to Lord for various sins are described; as well as
ways how to treat those who are unclean, and how to make them
clean again; how to preserve cleanliness of food; and how
to maintain long-term health of their communities. Leviticus is
probably the oldest written code of food hygiene, epidemiology,
and reproduction and community health. This community health
code imposed on the peoples of Israel contains many rules which
are still relevant today. In historical context they certainly did have
justification based on empirical experience and contemporary
knowledge. The role of guardians of human health at population
level did not belong to medical professionals though, but to the
priests. Priest was the authority that had the power to pronounce a
person or a house clean and unclean; and to impose remedies
which would prevent spreading of a contagious disease to others.
The code presents in great detail animals and foods which shall not
be eaten by people, and sometimes not even touched to preserve
cleanliness of an individual and the community. Leviticus, the third
book of the Bible, prioritizes health and well-being of the
community over the rights and well-being of an individual. Those
who were unclean were openly ostracized, and only allowed to
socialize when they became clean again; while those wicked and
deformed, either physically or mentally, were excluded from society
and from reproduction. From population perspective, higher death
rate was compensated by higher birth rate. This directly relates
to ban on methods limiting reproduction and ban on abortion.
Social pathologies were then consistently punished by death. This is
the original code which is still used by some Middle Eastern
cultures to this day. There is very little difference between the
teachings of Quran and the Old Testament, and it cannot be
overlooked that they both stem from the same source. The only
substantial difference is that the secular Euro-American civilization
no longer considers these ancient teachings binding because it had
the time and opportunity to evolve and develop a sophisticated
parallel legal system which is, in the difference from religious
teachings, binding for all members of society as defined by the

DARK SIDE OF A MOUNTAIN
3
respective jurisdiction, and not just for followers of a specific faith.
Religion and legal system separated in two already under the
Romans. In ancient Rome, monotheistic Jewish community was
more or less allowed to govern itself by its own laws. The character
of Jesus is portrayed in all four gospels in minute detail and with
great consistency. In the absence of forensic evidence, books of the
Bible are the only proof available with regards to physical existence
of Jesus. The Romans reserved death by crucifixion for rebels
against the Roman State. Crucifixion of Jesus is described in all four
gospels in graphic detail, and is also mentioned in other historical
records including Tacitus in parts where he elaborates on Pontius
Pilate and Emperor Tiberius. Jesus, the King of the Jews, was
perceived as political threat to the Roman State because of his
subversive teachings. As per Harvey’s book ‘Jesus and the
constraints of history‘1
, early Christians denied any such activity
and portrayed Jesus only as a religious teacher and not as a freedom
fighter.
The legal grounds for his crucifixion remain rather obscure and
historians still consider several possible scenarios. As mentioned
by Philo of Alexandria, Pontius Pilate frequently carried out
executions without trial and the possibility of crucifixion of an
innocent person through miscarriage of justice or simple abuse
of power cannot be ruled out. There is also the possibility that the
verdict was influenced by pressure from the Jewish community
itself and Jesus was executed to meet popular demand, simply
because his teachings were very provocative, and because he
attracted high degree of animosity among fellow Jews. Jesus’s
arrival to the Mount of Olives on a donkey was a monumental
provocation since he had the authority to require transport.
Excitement of the crowds did not last long though. He could have
been handed over to the Romans after being condemned to death
for blasphemy although this possibility is denied by Luke who
clearly stated that Jesus was not found guilty by any Jewish court.
Luke, Paul, and Peter sing in consonance that those who are found
guilty of blasphemy and idolatry shall be put to death by ‘hanging
upon wood’ (crucifixion). The reasons for him being handed over
1
Harvey, AE. 1982. Jesus and the Constraints of History. Westminster John Knox
Press.

VERONIKA VALDOVA
4
to the Romans could be envy and jealousy as concluded by Mark or
sheer ignorance which is what Luke apparently thought about the
motivations.
Jesus’s attitude to Jewish law was highly disrespectful and
provocative, especially his violations of food laws and
transgressions of Sabbath. True is that the violations were not
prosecuted. Food laws are still central to Jewish religion today.
Jesus pronounced all foods clean and human waste unclean, and
did not fast. He did not wash his hands before meals and did not
share the ambition of the Code of Conduct. Jesus provoked the
community among other things by the company he kept because he
rejected the traditional Jewish social exclusiveness. In essence, Jesus
challenged Jewish way of life and by challenging the Law of Moses.
Many perceived Jesus was a false prophet and believed that the
name ‘Christ’ he used meant ‘end of the Law’. Jesus demanded
noting less but extension of the Laws of Moses from the ‘Code of
Conduct’ or ‘Change of Behavior’ to much more profound
transformation, and that was change in the ‘Way of Thinking’.
While Moses required people to refrain from ‘homicide’ and
‘adultery’, Jesus asked them to go much further and refrain from
‘anger’ which is the core emotion leading to homicide, and ‘desire’
which is the core cause of ‘adultery’. The Laws of Moses pay lot
of attention to damages in law and compensations for insult or
injury. Jesus’s demand was not only to refrain from insulting and
harming others, but also to show love to one’s enemies. It was Jesus
who renounced the option of divorce which was present in Jewish
law.
The moment in history was widely perceived as exceptional. The
general excitement of the masses led to neglect of duties which
would otherwise be intolerable, such as the tradition to bury one’s
own parents expressed as ‘Let the dead bury their dead’. There was
a widespread expectation of an imminent end, a kind of apocalypse,
the end of history or a significant change, such as new social order.
No matter how controversial figure Jesus was when he was alive, he
was acknowledged as a prophet by all. The name ‘Messiah’ was
understood by all without further description. No end of history
occurred; but dis-confirmation of prophecy does not diminish
credibility of a prophet. Jesus did not conform to a known pattern
of a healer, magician, shaman, or exorcist; and was believed

5
to possess extraordinary powers of prolonged concentration which
is rather common among Buddhist monks. The diseases he cured
were those which were disabling but curable using natural
phenomena not widely known and understood at that time.
The choice of name became eventually the core of the claim.
Calling himself ‘Jesus the Christ’ meant that he did lay a claim on
his Messianic status. If Jesus was ‘authorized’ to act as he did which
means as the Son of God, he must have been either obeyed and
followed or eliminated for blasphemy. While Christians
acknowledged his claim for Messianic status and followed his
teachings, the Jews did not. The Christian doctrine in fact
challenged the oneness of God but this was never understood
by the Jews in literal sense of this claim, just like the virgin birth
which is central to Christianity.
But this is not the only possible explanation of the reasons of his
crucifixion. There is also a possibility that Jesus offered himself
to the authorities as a ransom for many to prevent genocide of the
entire nation. This explanation was offered by Caiaphus who
advised Sandherin that Jesus shall be handed over to the Romans
to be executed rather than the whole race to be destroyed. In this
sense this would be a reminiscence of the attempted genocide and
the birth of Jesus would symbolize recovery of a nation.
Nevertheless, Jesus was handed over to the Romans on political
grounds, not religious. The Jews charged Jesus with blasphemy but
found him not guilty, while the Romans believed he was guilty
of sedition. Although Jesus was not found guilty by the Romans he
was put to death anyway, and his death launched a cultural
avalanche.
Separation of Christian Church and State only started during the
Protestant reformation due to Martin Luther’s Doctrine of the Two
Kingdoms. With separation of Church and State only rules created
by man became legally binding. In a way, the situation back then
resembles current tolerance of Sharia law by western cultures
on their territory. Certain communities are allowed to impose their
own religious laws upon their own people no matter what the legal
code of the country they reside in says.
The rules imposed by the Book of Leviticus on the people of Israel
can still be found in contemporary legal documents and guidelines.

VERONIKA VALDOVA
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It makes very good sense not to touch and eat carcasses of animals
which ‘died of themselves’ or those not slaughtered in a controlled
manner because of risk of infection and potential of spread
of deadly diseases. It also seems justified to isolate those who do
touch things and creatures which are 'unclean and abominable'
from others, because both ignorance and willful violation of a these
rules would threaten the life and health of everyone else. Does the
same set of rules in literal sense apply today? Hardly. But there is
no doubt about the relevance of hygiene standards including
isolation of sources of potentially lethal contagious diseases and
people in incubation period of deadly infectious diseases. The only
difference is that food hygiene standards in food processing were
transposed from a religious code, binding only for those who
adhere to a particular faith, to a civil code which is legally binding
for all those who reside in a respective territory.
Or if a soul touch any unclean thing, whether it be a carcass of
an unclean beast, or a carcass of unclean cattle, or the carcass
of unclean creeping things, and if it be hidden from him; he also
shall be unclean, and guilty. [Leviticus, chapter 5, verse 2]
Moreover the soul that shall touch any unclean thing, as the
uncleanness of man, or any unclean beast, or any abominable
unclean thing, and eat of the flesh of the sacrifice of peace
offerings, which pertain unto the LORD, even that soul shall be
cut off from his people. [Leviticus, chapter 7, verse 21]
Our ancestors had a good reason to be scared of certain 'beasts that
shall not be eaten'. It is not wise to keep pigs in areas where
shortage of clean water is a continuous concern, and where
contamination of this precious resource with sewage which pigs do
indeed produce in very large quantity would threaten entire
communities which depend on such resource. Another concern
would be Trichinella spiralis, a parasite which resides in pork
muscle tissue, and causes devastating disease in those who eat
pork. Trichinosis would be a very good reason why people at that
time did not think that pork is safe to eat. Rabbits, hares, and
snakes, and creatures that 'live in water that have not fins and
scales' (seafood), are now considered perfectly safe to eat providing
they meet hygienic standards; and the reasons for avoiding some
of them are only cultural. However, these rules did make perfect
sense back then. Seafood contaminated with waste water would not

7
be safe to eat. In addition to that there was no way how to transport
and store fresh seafood safely so it would become a dangerous
source of food poisonings. At more abstract level, environmental
protection standards which were described in the Book of Leviticus
are still relevant today. We are no longer worried about pigs
spoiling our wells because we understand the risks well enough to
be able to manage them; but in more abstract terms we still do
worry about environmental pollution which has the potential to
destroy water and soil and contaminate the food chain. The ancient
code was superimposed by rules which reflect the level of
knowledge people now have. Very little has changed in the sense
that predators, rodents, and birds of prey are not considered edible
by most cultures; and consumption of insects is limited to very few
edible species which always exclude any necrophorous species.
Operation rooms are divided into sterile (clean) and non-sterile
(unclean) areas; and people are expected to follow hygienic
standards when handling dead animals and other unclean or
potentially infected materials.
These rules of cleanliness were temporarily forgotten during the
Middle Ages, the Dark Age, when hygiene became a very serious
problem in overpopulated urban areas. The exact content of the
Bible was changing over time and inclusion and exclusion
of chapters had to be approved by papal councils. The Hebrew Bible
was not part of Christian religious doctrine in early Middle Ages
when rejection of the Laws of Moses by Jesus was still well
remembered. Should the rule on clean and unclean status of certain
animal species be followed, rats and fleas would never become a
problem as devastating as they were during the plague pandemic.
Apparently, medieval priests paid more attention to the part
on Holy water and Hyssop and focused less on the part on washing
one’s body and clothes. This failure to control plague pandemic was
not caused by unavailability or inaccessibility of the relevant
information. It was a failure caused by group-think, persecution
and elimination of ideological and scientific dissent, suppression of
information sources, and general unwillingness to challenge
unanimously accepted truth.

VERONIKA VALDOVA
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And that ye may put difference between holy and unholy, and
between unclean and clean; [Leviticus, chapter 10, verse 10]
And for these ye shall be unclean: whosoever toucheth the
carcass of them shall be unclean until the even. [Leviticus,
chapter 11, verse 24]
And whosoever beareth ought of the carcass of them shall wash
his clothes, and be unclean until the even. [Leviticus, chapter 11,
verse 25]
The most dangerous contagious disease of that time was leprosy,
which had to be distinguished from other illnesses with skin
manifestations. Priests had the authority to isolate an ‘unclean
person’ from others for a period of 7 days which would then be
either waved or extended, depending on status of the person’s
health. Priests as presented in the Old Testament did have certain
functions which now belong to different parts of state
administration. Among other duties they had the authority
to supervise population’s long-term reproduction and genetic
health. The phenomenon of sexual relationships within nuclear
family almost certainly occurred in some communities; encouraged
by relatively liberal attitude of the Romans and by the need
to preserve culture and unity of a small community in hostile
environment. Another motivator was important at that time just as
much as it is relevant in some cultures today and that was the need
to keep property within a family. The result would almost certainly
be genetic degeneration caused by inbreeding which the ancient
Book of Leviticus was anxious to prevent. Adultery threatened well-
being and survival of a family clan. Abandoned dependents who
had lost their breadwinner would have had very little chance
to survive in a harsh and unforgiving world. No matter how harsh
this was toward the offspring, survival of a community as a whole
was unaffected by the presence of illegitimate descendants who
were ostracized because of their origin and were generally utilized
as slaves.
In this context, the priests not only became the guardians
of morality, as they are now often perceived; their role was also
to keep up long-term genetic and behavioral health of the
community they looked after. They were the ones who isolated or
eliminated the 'insane', the 'undisciplined', and the 'wicked'.

9
Nowadays, people expect doctors to treat their bodies and minds,
both at individual and population level. Some cultures no longer
require religious service when people enter and leave this world: at
birth and at brink of death. One thing has not changed though:
people still expect both doctors and priests to be the ethical pillars
of society that never fall, because without them, gates of the
underworld would remain unguarded.
THE RIGHTFUL AND THE WICKED
The Book of Leviticus was not completely forgotten as it may seem.
Its teachings are extensively studied by some minority religious
movements such as Jehovah Witnesses who base their rejection
of blood transfusions on belief that blood is 'unclean'. The question
of consent with treatment and the right to refuse treatment dates
back to Hippocrates who had to explain the patient what the
physician is going to do with his body and what measures the
patient has to undertake to get healthy again. Ancient medicine is
now considered paternalistic; however, it is difficult to imagine an
ancient practitioner who would be enforcing any treatment on a
non-compliant patient who himself or whose family had to pay the
doctor directly. Major part of medicine in ancient Greece consisted
of dietary adjustments, something what is impossible without
patient’s understanding and willing cooperation. Contagious
diseases were a different matter, and patients affected by certain
diseases were seriously ostracized if they did not comply with the
regimen imposed upon them voluntarily. The Book of Leviticus is
very specific on the rules for patients with skin diseases and those
suffering from leprosy.
Patient’s refusal of blood transfusion on religious grounds is one
of the most controversial examples of conflict between medical
ethics and religion. Jehovah Witnesses consider refusal of blood
transfusions fundamental because acceptance of blood which is
sacred would prevent them from entering Paradise. Members of the
Church are required to observe this rule under threat of expulsion
from the community. Those who accept blood and revoke this way
their membership in the organization are then ostracized by the
community to the point that they are completely blanked by their

VERONIKA VALDOVA
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lifelong friends and family members who are still part of the
Church, and essentially treated as outcasts. The Watchtower
Society introduced the policy of refusal of blood transfusion in 1945.
Since 1961 it enforced zero tolerance towards those who willfully
accept blood transfusion. The number of deaths caused by refusal
of blood transfusion on religious grounds is estimated around 9,000
a year. Death caused by maternal hemorrhage is about 44 times
higher among Jehovah Witnesses than in general population2
.
Current medicine accepts the patient’s right to refuse treatment but
generally does not tolerate refusal of treatment for minors by their
parents.
According to the U.S. Supreme Court decision in the case Prince vs.
Massachusetts3
, parents are 'free to make martyrs of themselves;
but this does not follow that they are free, in identical
circumstances, to make martyrs of their children'. In practice, a
hospital would ask for an order permitting administration of blood
over parent’s objection. Jehovah Witnesses who refuse transfusion
are under significant influence of the Church, and one can argue
that their decision is not fully autonomous. One-to-one talk
between the patient and physician can help the patient to make an
autonomous informed decision on treatment. Confidentiality
between the patient and physician can make the patient more
willing to accept treatment without undue influences from outside.
People can and do reject cancer treatment and end-of-life medical
procedures, but this is a personal choice and not a policy enforced
by a Church or other authority.
Recently, Catholic Church in America attempted to enforce a ban
on birth control in some states for their followers4
. This idea
sparked nation-wide debate on insurance coverage and the need of
parental consent with prescription of birth control pills and
consent with administration of emergency contraception and
performing abortions in teenage girls. The debate on the
2
Radomyski, Mateusz. 2011. “Medical Oaths: When Religion and Ethics
Collide.” Amsterdam Law Forum 3 (1): 68–80.
3
Prince vs. Massachusetts. 1944. U.S. Supreme Court.
4
Chapin, Laura. 2012. “Mitt Romney and the GOP’s War on Birth Control.” US
News, February 6.

11
implementation of rules defined in the Old Testament is ongoing
and probably never ending, and there will always be more than one
way of looking at the matters from individual human rights vs.
population health perspectives.
THE GUIDE FOR THE PERPLEXED
Hebrew physician and philosopher Moses Maimonides, in Hebrew
known as 'Rabbi Moshe Ben Maimon', or 'RaMBaM', and in Arabic
literature as Abu 'Imran Musa ben Maimun ibn 'Abd Allah.
Maimonides was born in the Spanish city of Cordoba in 1135 and
died in Fostat (Cairo) in Egypt in 1204. Moses was only thirteen
years old when Cordoba fell into the hands of fanatical Almohades,
and his family was forced into exile where they led a nomadic life
for twelve years. In 1160 they settled at Fez, pretending to be
Moslems. Maimonides' reputation of a physician was steadily
growing and this made him more visible to the authorities which
even charged him with the crime of having relapsed from Islam.
In 1165 Maimonides’ family left for Acre, continued to Jerusalem,
and then to Fostat (Cairo), where they settled. He made a living as a
physician and authored ten medical works including the Oath
of Maimonides. He gained fame mainly from his work on Jewish
law, chiefly the 'Book of the Commandments'5
, 'The Pentateuch';
'Commentary on the Mishnah'6
; 'The Law in Review'7
; and
masterpiece written in Arabic 'The Guide to the Perplexed'8
in which he tried to address apparent disparity between biblical
and scientific and philosophical ideas for the readers of the Torah.
This effort to apply rational thinking was not always met
with understanding. Denounced to Church authorities by Jewish
adversaries, the first and most thematic volume of Maimonides'
5
Maimonides, Moses. 1204. The Book of the Commandments: Kitab Al-Fara’id
(Sefer Ha-Mitzvot).
6
Maimonides, Moses. 1204. Commentary of the Mishnah: Kitab Al-Siraj (Sefer
Ha-Maor, Perush Ha-Mishnah).
7
Maimonides, Moses. 1204. Mishneh Torah (The Law in Review).
8
Maimonides, Moses. 1204. The Guide for the Perplexed. Translated from the
original Arabic text by M. Friedlander in 1904.

VERONIKA VALDOVA
12
code, the Sefer ha-Mada (Book of Knowledge), was burnt
at Montpellier in 1232, along with The Guide to the Perplexed9
.
In the Guide for the Perplexed, Maimonides pays lot of attention
not only to philosophical issues of that time with regards to deity;
but also explains rationale behind the Book of Leviticus and its
practical implications on daily life and on medical practice:
Males or females that are unclean through running issue, and a
woman after childbirth, must in addition bring a sacrifice,
because their uncleanness occurs less frequently than that of
women in their separation. All these cases of uncleanliness, viz.,
running issue of males or females, menstruations, leprosy, dead
bodies of human beings, carcasses of beasts and creeping things,
and issue of semen, are sources of dirt and filth. We have thus
shown that the above precepts are very useful in many respects.
First, they keep us at a distance from dirty and filthy objects:
secondly, they guard the Sanctuary; thirdly, they pay regard to
an established custom (for the Sabeans submitted to very
troublesome restrictions when unclean, as you will soon hear):
fourthly, they lightened that burden for us; for we are not
impeded through these laws in our ordinary occupations by the
distinction the Law makes between that which is unclean and
that which is clean. (The Guide for the Perplexed, p 524)
Another custom among the Sabeans, which is still widespread, is
this: whatever is separated from the body, as hair, nail, or blood,
is unclean; every barber is therefore unclean in their estimation,
because he touches blood and hair; whenever a person passes a
razor over his skin he must take a bath in running water.” (The
Guide for the Perplexed, p 525)
Compliance with this practice would have made a fundamental
difference during the plague epidemic because it would mean
isolation of people who ‘come in contact with unclean animals such
as rats’, and, more importantly, would introduce hygienic practices
for those who get in contact with ‘whatever is separated from the
body’ should it be blood, issue, or any other surgically removed or
opened structure. This rule effectively described principles of clean
surgery.
9
Islamic Philosophy Online, Inc. n.d. “The Muslim Philosophy.”

13
Blood (Lev. xvii. 12), and nebelah, i.e., the flesh of an animal that
died of itself (Deut. xiv. 21), are indigestible, and injurious as
food: Trejah, an animal in a diseased state (Exod. xxii. 30), is on
the way of becoming a nebelah. (The Guide for the Perplexed,
p 528)
The commandment concerning the killing of animals is
necessary, because the natural food of man consists
of vegetables and of the flesh of animals: the best meat is that
of animals permitted to be used as food. No doctor has any
doubts about this. Since, therefore, the desire of procuring good
food necessitates the slaying of animals, the Law enjoins that
the death of the animal should be the easiest. It is not allowed
to torment the animal by cutting the throat in a clumsy manner,
by pole axing, or by cutting off a limb whilst the animal is alive.
It is also prohibited to kill an animal with its young on the same
day (Lev. xxii. 28), in order that people should be restrained and
prevented from killing the two together in such a manner that
the young is slain in the sight of the mother; for the pain of the
animals under such circumstances is very great. There is no
difference in this case between the pain of man and the pain
of other living beings, since the love and tenderness of the
mother for her young ones is not produced by reasoning, but
by imagination, and this faculty exists not only in man but
in most living beings. This law applies only to ox and lamb,
because of the domestic animals used as food these alone are
permitted to us, and in these cases the mother recognizes her
young. (The Guide for the Perplexed, p 528-9)
E.g., bodily exercise, in its different kinds, is necessary for the
proper preservation of health in the opinion of him who
understands the science of medicine; writing is considered as
very useful by scholars. (The Guide for the Perplexed, p 448)
The comment above reminds people of the duty to treat humanely
animals which are slain for food. The Book of Leviticus as explained
and presented by Maimonides did not require obedience without a
reason. All measures described in the Hebrew Bible in his eyes had
rational justification. There are many practices which are described
in the text below which were forgotten in the coming centuries

VERONIKA VALDOVA
14
because they were considered heretical. As per Maimonides, good
diet and exercise are the most important conditions of good health;
and medicine to be effective shall be based on observation and
experiment. Maimonides clearly rejected astrology which he
compared to witchcraft, having no sympathy for this
pseudoscience. This is the book which was burned by the Christians
at Montpelier in 1232, along with many other 'heretical texts'.
[The Law prohibits] everything that the idolaters, according
to their doctrine, and contrary to reason, consider as being
useful and acting in the manner of certain mysterious forces.
Comp. 'Neither shall ye walk in their ordinances' (Lev. xviii. 3)
and 'Ye shall not walk in the manners of the nation which I cast
out before you' (ibid. xx. 23). Our Sages call such acts 'the ways
of the Amorite': they are kinds of witchcraft, because they are
not arrived at by reason, but are similar to the performances
of witchcraft, which is necessarily connected with the influences
of the stars; thus ['the manners of the nations'] lead people
to extol, worship, and praise the stare. Our Sages say distinctly,
'whatever is used as medicine' does not come under the law
of 'the ways of the Amorite': tor they hold that only such cures
as are recommended by reason are permitted, and other cures
are prohibited. (The Guide for the Perplexed, p 481-2)
The uterus of animals which have been selected for the
Sanctuary must be buried; it must not be suspended from a tree,
and not buried in the cross-road, because this is one of 'the ways
of the Amorite.' Hence you may learn how to treat similar cases.
It is not inconsistent that a nail of the gallows and the tooth of a
fox have been permitted to be used as cures: for these things
have been considered in those days as facts established
by experiment. They served as cures, in the same manner as the
hanging of the peony over a person subject to epileptic fits, or
the application of a dog's refuse to the swellings of the throat,
and of the vapors of vinegar and marcasite to the swelling
of hard tumors. For the Law permits as medicine everything
that has been verified by experiment, although it cannot
be explained by analogy. (The Guide for the Perplexed, p 482)
Of the letters written after the completion of the 'Guide,' the one
addressed to the wise men of Marseilles (1194) is especially

15
noteworthy. Maimonides was asked to give his opinion
on astrology. He regretted in his reply that they were not yet
in the possession of his Mishneh Torah; they would have found
in it the answer to their question. According to his opinion, man
should only believe what he can grasp with his intellectual
faculties, or perceive by his senses, or what he can accept
on trustworthy authority. Beyond this nothing should be
believed. Astrological statements, not being founded
on any of these three sources of knowledge, must be
rejected. He had himself studied astrology, and was convinced
that it was no science at all. (The Guide for the Perplexed, p 21)
In Egypt, the family no longer had to hide their Jewish faith, and
Maimonides gained fame as a physician. Famous Muslim military
leader Sultan Saladin and his son al-Afdal were among his patients
among many other high profile figures of that time. His influence
on Judaism extended to the larger world; and his philosophical
texts influenced great medieval Scholastic writers, and even later
thinkers, such as Benedict de Spinoza and G.W. Leibniz. His
medical writings constitute a significant chapter in the history
of medical science. According to 20th
century historian Waldemar
Schweisheimer10
, Maimonides’ medical teachings are not
antiquated at all; in fact they are astonishingly modern in tone and
contents.
10
Bokser, Rabbi Ben Zion. 2013. “Moses Maimonides.” Encyclopedia Britannica.

16
II. THE BLACK DEATH
The two plague pandemics which ravaged Europe in 6th
and 14th
centuries inflicted enormous numbers of casualties and caused
profound changes in society ranging from philosophical to economic.
Corpses infected with plague were used during the Mongol attack
on Caffa in 1346. Although this incident effectively started the 14th
century plague pandemic it was not its cause. Plague is still
considered a potential weapon which could be utilized by terrorists;
and contingencies are planned for the eventuality of an attack or
spontaneous outbreak. Conditions which were necessary
for escalation of local outbreak to a pandemic were numerous, and
included overpopulation, lack of hygienic standards, elimination
of ideological and scientific dissent, suppression of information
which did not conform to the only authorized life-science doctrine,
elimination of any alternative ideas and life-science doctrines
together with their proponents, exclusion of the Hebrew Bible
from religious teachings, and most importantly loss of autonomy
of the subjugated populations as the core causes. Group-think was
the result of several centuries lasting systematic elimination
of critical thinkers who were the only people who had the capacity
to recognize true nature of the disease, and find a way of stopping the
pandemic.
Plague, a disease known already to the Pharaohs, swept through
Europe in 14th
century and claimed 25 million lives in the first wave
and another 25 million in those which followed. The same disease,
now recognized as the Justinian Plague, ravaged Byzantine Empire
in 541-542 AD and claimed about 25 million lives in the Middle East
and Eastern Mediterranean. This was very considerable part of the
population and the worst pandemic on record. Yersinia pestis11
,
Gram-negative bacteria with typical safety pin appearance, is
primarily a rodent pathogen. Humans get infected when bitten by a
rat flea which carries the bacteria in its guts where the microbes
multiply. When feeding on animal or human blood, fleas
11
Bednar, Marek, Vera Frankova, Jiri Schindler, Andrej Soucek, and Jiri Vavra.
1996. Lekarska Mikrobiologie. Marvil.

17
regurgitate part of the blood they have in their stomachs including
the pathogen, and transfer the infection to the host. While growing
in the flea, Yersinia pestis loses its capsular layer which is its main
protection against phagocytosis by macrophages. When transferred
to animals or humans, most of the bacteria are killed by the
immune system, but some are taken up by tissue macrophages
which are unable to kill them and provide protected environment
for the organisms to synthesize their virulence factors. A
macrophage then serves like a Trojan horse for the pathogen. Upon
release, Yersinia pestis quickly spreads to regional lymph nodes
which become swollen, tender, and hot. These massively enlarged
lymph nodes are responsible for main symptom of bubonic form
of plague, the characteristic buboes. Within hours of the initial flea
bite, the pathogen spreads in the bloodstream and affects liver,
spleen, and lung tissue.
Whilst untreated bubonic form of plague has mortality about 50 to
60% of patients, pulmonary form and plague septicemia are nearly
100% fatal. Apart from the typical buboes, the symptoms include
high fever and chills, general malaise, headaches and body aches,
and vomiting and nausea. Pulmonary form causes people to cough
bloody sputum in severe fits. Plague septicemia is so fast that
people do not develop the typical buboes before they die. Plague
gets transferred from infected rats to humans through fleas which
serve as a vector of the disease, and then, as the epidemic
progresses to its pulmonary form spreads from one person to
another12
.
12
Chamberlain, Neal R. 2010. “Lymphoreticular and Hematopoetic Infections:
Plague.”

VERONIKA VALDOVA
18
THE JUSTINIAN PLAGUE
The oldest epidemic of plague was recorded in ancient Egypt13
.
Archeologist Panagiotakopulu searched burial sites for remains of
insects and small rodents to find out what diseases ancient
populations might have had, and discovered a plague infested flea.
Black rat was endemic to India and spread to ancient Egypt
on board of merchant ships. For plague to move from rodents
to humans and cause an epidemic or pandemic, the sylvatic brown
and gray rats which otherwise stay in the wild need to come
into contact with black rat or people themselves. Panagiotakopulu
believes that the main impulse which forced Nile rats and their
plague-infested fleas to move closer to human settlements and
share environment with people were periodic floods. Contact
between sylvatic and urban rat populations was possible due
to existence of grain silos and storage sites in which both rat types
exchanged fleas and ultimately spread plague to humans. Ebers
Papyrus, medical text written about 1500 B.C., describes an
epidemic of a disease which looks like bubonic plague. Although
in the ancient world plague was a well-known disease, it mostly
caused localized outbreaks which were self-limiting - until the
pandemic of 541.
Justinian Plague is believed to have been imported either
from Ethiopia or Egypt, where plague was present in sylvatic form
among population of brown, gray, and black rats. The disease likely
spread to Europe on the backs of shipboard black rats which carried
plague-infested fleas. Subsequent epidemics which followed in 6th
,
7th
, and 8th
century, were more localized and less deadly, but caused
so much disruption that eventually led to demise of the Byzantine
Empire. Based on the accounts of Procopius, a 6th
century historian,
the origin of Justinian plague can be traced to the port of Pelusium
where it was first reported in 541 AD. From Pelusium it spread to
Alexandria and throughout Egypt, and consequently in 542 through
Constantinople to Asia Minor, Greece, Italy, France, Spain, and
13
Walker, Cameron. 2004. “Bubonic Plague Traced to Ancient Egypt.” National
Geographic News.

19
eventually north into the British Isles. Orent14
in her book on the
history future of plague argues that although Justinian I was not
responsible for creating the disease, he created conditions which
allowed the pandemic to break out. Until then, plague did exist
in urban settings but its outbreaks were localized. The pandemic
followed the movements of men and goods in Justinian’s
resurrected Roman Empire and was essentially the consequence
of imperial overstretch, and globalization of economy and
centralization of vital resources.15
Without the empire, the bread dole, the huge shipments of grain
and clothes from Africa, it is difficult to imagine how the First
Pandemic could ever have erupted. (Orent, 2004)
As per Procopius, the 6th
century citizens of Constantinople
suffered from shortage of food as a result of an extended period
of cold weather and low sunshine, and were therefore weakened
and prone to disease. This mini nuclear winter is believed to have
been caused either by a comet hitting the earth or the eruption of a
massive volcano16
. This climatic anomaly affected the harvests and
ability of the locals to achieve self-sufficiency in basic food supply;
and many of the inhabitants, especially the poor, were becoming
dependent on bread dole. Marjolein Schat in her paper 'Justinian’s
Foreign Policy and the Plague: Did Justinian Create the First
Pandemic?' explains how huge warehouses and bread dole
in Justinian’s Empire created the plague pandemics of 541:
The grain tribute from Africa was approximately 240 metric tons
per year (Evans 1996) and primarily went to Constantinople
where it was used in a bread dole to feed the people of the city.
The grain was brought to Constantinople by ship across the
14
Orent, Wendy. 2012. Plague: The Mysterious Past and Terrifying Future of the
World’s Most Dangerous Disease. Free Pres.
15
Geographic News.
16
Geographic News.

VERONIKA VALDOVA
20
Mediterranean Sea. Bad weather and heavy seas closed the
Mediterranean Sea to shipping from November to March, and it
was still dangerous an additional two months on either side of
the closed period (Temin 2001). With only four “safe” months
out of a year in which grain could be shipped, horrea
(warehouses) were built to store the grain. The early horrea of
Ostia and Rome were 60 foot by 100 foot one storey buildings
(Vitelli 1980), but in Constantinople some have been reported as
large as 90 feet by 280 feet and “ineffably” tall (Evans 1996). The
horrea were ideal breading grounds for rats and fleas, and Orent
(2004) claims that the combination of these plague factories and
expanded trade routes were the catalyst for the plague going
from an outbreak to epidemic and then to pandemic. (Ibid)
Important factor which contributed to spread of the Justinian
Plague was gradual but profound loss of individual freedoms which
came with feudalism. Consequent loss of autonomy resulted in loss
of ability to employ protective measures at individual level.
Increasing dependence of the most vulnerable part of the
population on bread dole facilitated the spread of plague
from infected horrea to people who had no other options but
to take what was given to them. Another important factor was the
spread of Christianity which was in its early stages based on series
of dogmas which could not be challenged. Causal factors of the
medieval plague, the so-called ‘unholy trinity’ were bacterium
Yersinia pestis as a pathogen, the black rat as a reservoir, and a flea
as a vector. Without these three factors present all at once no
outbreak can occur. But not even these factors together would
cause a pandemic by themselves because they require other
conditions to manifest full force. The essential conditions are
existence of a reservoir of sylvatic population of infected rodents;
existence of population of urban or shipyard rodents; place where
the two populations come in close contact to allow transfer of
infected fleas between the two populations which are normally
separate; contact between people and fleas from infected rodents or
via infected fleas once the rodents had been disposed of; and
eventually during later phases of the epidemic through direct
contact between infected people and contact with dead corpses and
their belongings and clothes. During the Justinian Plague, infected
rats were imported on board ships and their introduction into naive
environment and contact with sylvatic rats created a reservoir

21
which would cause subsequent series of outbreaks in the following
decades. Contact between infected rats and fleas in grain silos was
one route of transmission, the other being transfer from infected
fleas hiding in clothes to people who were handling the shipments.
So far the pathogenesis is clear as presented in mainstream
literature but the story does not seem to be complete just yet
because 19th
and 20th
century bubonic plague outbreaks have
completely different dynamics than the medieval form. The
medieval Black Death pandemic was not an inevitable disaster
caused by adversity of nature but a combination of natural factors
and man-made conditions which allowed it to become as deadly as
it was. Essential condition for a plague outbreak is a contact
with reservoir. If the local population of sylvatic rats is already
infected, the essential condition required is the contact between
sylvatic and urban population of rats which then come in contact
with domestic animals and people. Expanded shipping routes
which reach reservoirs further away increase the probability that a
reservoir will eventually be reached. Under any other
circumstances, if there were any alternative trade routes outside
plague infested regions, the fact of reaching a reservoir would be a
mere aggravating condition of the pandemic. But because there
were no alternatives, and the empire could not cope without supply
of essential commodities from North Africa, the relationship
between plague-infested regions and the Byzantine Empire became
that of a cause and effect because of strategic dependence of the
Empire on clothes and grains from North Africa. Single point
of entry (Constantinople) then played the role of a critical
condition because the port could not be shut down. From
Constantinople the infection got into the local supply through
horrea and due to the bread dole it was pushed to people who had
no way of avoiding the infected material. Due to outbound shipping
it was spread globally to other ports. At the same time, the
population was becoming impoverished and unable to employ even
the most basic precautions to protect themselves against spread
of the disease. Long wars abroad sucked up resources which were
desperately needed elsewhere. This lack of capacity to cope at
individual level was worsened by lack of investment in public
infrastructure such as baths and waste management, and lack
of capacity or will to improve the living standard of the population.

VERONIKA VALDOVA
22
Causes and conditions of the plague pandemic
Causal factors Plague
Presence of a causative agent:
bacterium Yersinia pestis
} 'Unholy trinity'
Presence of a primary host: rats
Presence of a vector: fleas
Conditions Outbreak
→ Epidem ic
→ Pandem ic
Existence of a reservoir: sylvatic
population of infected rodents
Y
(essential)17
All essential factors
have to be present
to produce an
outbreak.
↓
Multiple
unprotected routes
 multiple ways of
transfer
 tautology
18
Existence of a population of
urban or shipyard rats
Y (essential)
Presence of an infected vector
(flea)
Y (essential)
17
Y (essential) = necessary conditions which have to be present all at the same
time to produce an outbreak, not sufficient by itself. If any of these conditions is
missing, the outbreak does not occur.
18
Tautology: if any of 1-n variables is true, X will happen. Probability of X
happening increases with number of variables.

23
Causal factors Plague
Conditions Outbreak
→ Epidem ic
→ Pandem ic
Contact between susceptible
human and infected rats (A)
Y (optional –
either of A
conditions)
All essential
factors have to
be present to
produce an
outbreak.
↓
Multiple
unprotected
routes
ways of transfer
 tautology
19
Contact between susceptible
human and infected flea (A)
Y (optional –
either of A
conditions)
Contact between susceptible and
infected human ^causative agent
capable of transfer via direct
contact (A)
Y (optional –
either of A
conditions)
Handling dead bodies20
(presence of an infected vector is
required, e.g. fleas on clothes 
animals feeding on infected
flesh)
Y (strengthens
effect of other A
conditions)
OUTBREAK

EPIDEMIC

PANDEMIC
Causative agent + vectors + susceptible host + (any of A) conditions =>
outbreak
Causative agent + vectors + susceptible host + (all of A) conditions =>
epidemic or pandemic
19
Tautology: if any of 1-n variables is true, X will happen. Probability of
X happening increases with number of variables.
20
Broughton, Methew J. 2014. “Catapulted Death: Can a Flying Corpse
Distribute the Plague?” Insects, Disease, and History.

VERONIKA VALDOVA
24
In ancient times, the infection killed nearly 100% of all infected
patients and spread at enormous speed, roughly the same distance
a day as current plague in a year. During the World War Two
Japanese physician Ishii Shiro from Unit 731 in Japanese occupied
Manchuria experimented with bubonic plague for its potential
to be used as bacteriological warfare. When the war was over,
thousands of plague and tularemia-infected rats were released
in the wild. The disease did not spread like medieval plague but was
largely self-limiting. It is likely that the bacterium mutated as well
and over the centuries lost its main virulence factors.
Susceptibility to the disease is another factor to be considered
because the survivors acquire lifelong immunity which protects
them from subsequent outbreaks. In addition, certain genotypes
are more resilient to the disease than others. This natural resistance
was caused by a mutation which some researchers believe is the
same as mutation CCR-5 Delta 32 which prevents the pathogen
from entering macrophages and is responsible for resistance against
HIV. This allele is unique to European population and is not at all
present in Asia, India and the Middle East; places which were
ravaged by medieval plague the same way or even more than
Europe. Whether there is a connection between mutations in this
particular gene and the selection pressure caused by the medieval
plague pandemic remains unanswered21
.
21
Cohn, SK, and LT Weaver. 2006. “The Black Death and AIDS: CCR5-32 in
Genetics and History.” QJM 99 (8): 497–503.

25
Causes and conditions which led to the Justinian plague
Expanded shipping routes
reaching other reservoirs
Y - Essential
condition in
absence of causal
factors AND
aggravating
condition if causal
factors are already
present
Y - essential
condition for
creation of
pandemic:
absence of
alternatives AND
presence of
conditions for
epidemic
Economy of an empire
dependent on trade with remote
places, supply of essential
commodities (grain and clothes)
from North Africa to a single
port creating strategic
dependence
Y – Cause and
effect. Dependence
on causal factor
AND aggravating
condition
Imperial overreach  high taxes
imposed to cover war expenses
and ambitious building projects
which sucked up resources and
impoverished local population 
loss of autonomy (B)
Y (optional – either
of B conditions)
Y – inability to
take precautions
at individual
level
Lack of investment in public
infrastructure (baths) lowering
standard of hygiene including
pest control (B)
of B conditions)
Y – weakening of
defenses at
multiple levels
Bread dole  dependence on
the ruler: inability of local
population to find alternative
sources / move due to reported
poverty  changes towards
feudalism  entrapment of
population at risk: loss of
autonomy AND existential
dependence
of B conditions)
Y – inability to
take precautions
at individual
level (true for
most of Europe)

VERONIKA VALDOVA
26
THE 1348 PLAGUE
But the worst was still to come. European culture forgot about its
roots and entered a period which is now called the Dark Ages.
Religious fundamentalism engulfed Europe and kept its inhabitants
in submission, obedient and compliant. Medical science
degenerated from Hippocratic concept of empirical learning and
respect to nature and life to a very abstract way of explaining the
origin of human illness and suffering as consequence of the wrath
of God. Astrology, a science which was once by Maimonides
described as backwards pseudoscience was now becoming
mainstream life-science.
The authority to provide treatment to individuals and population as
a whole shifted from physicians to priests once again. Many books
were burned; many lessons learned in the past the hard way were
forgotten and replaced with religious doctrines. In 1346, pestilence
once again spread throughout Europe; this time from Crimea,
where it probably broke out as the result of biological warfare
attack during the Siege of Caffa22
. Mark Wheeling in his paper
refers to Gabriele Mussi’s memoir in which the onset of deadly
disease is described in great detail. Tartars and Saracens who were
coming in large numbers from the East were falling ill with a deadly
disease which was unknown in the area at that time and resembled
bubonic plague. The Mongol army hurled large numbers of plague-
infected cadavers into the besieged Crimean city of Caffa, disposing
off of corpses and transmitting the disease to the inhabitants.
Consequently, the fleeing survivors of the siege spread plague from
Caffa to the Mediterranean Basin. Mussi also mentioned that the
Italians fleeing from Caffa spread the disease to other Italian ports.
Crimea is widely accepted as the origin of the 13th
century plague
outbreak in Europe. Even though the Siege of Caffa was one of the
points of entry, according to Wheeling it was not a decisive one.
There were many other routes which allowed spreading of the Black
Death, mainly through merchant ships which always had enough
22
Wheelis, Mark. 2002. “Biological Warfare at the 1346 Siege of Caffa.” Emerg
Infect Dis [serial Online], September 2002.

27
rats on board. Killing off the rats on board ships made the situation
even worse, because hungry fleas started feeding on human blood
and spread the disease even faster. With incubation period 2 to 6
days, infection during unloading of goods full of fleas would allow
enough time to spread the plague to yet another port.
From Crimea, plague spread to Constantinople, Asia Minor, Cyprus,
Crete, Sicily, Sardinia, Corsica, and Marseille which it reached
in January 1348. By June the same year, it continued spreading
through North African ports, swept through Greece, the Balkans,
Venice and Papal States, Castile, and Aragon to France and all the
way to Normandy, and then through Calais to Bristol and London.
Alps and the Pyrenees did not stop the plague. Interestingly,
Danube lowlands which had extensive trade with Crimea, too, were
only affected by plague which was spreading from the South in late
1949 and 1950, and not directly from Crimea. By 1349, plague
pandemic affected most of England and Wales, Southern part
of Scotland and Ireland, Western Castile and Portugal, Southern
part of Norway, Rhine and Danube lowlands, and eventually in 1350
remaining part of northern and eastern Europe around the Baltic
and all the way to Russian steppe. Only Poland was spared and
apparently suffered very few deaths23
.
Causes of the 1348 plague pandemic
The plague pandemic is the worst natural disaster on record. It has
been extensively studied by scholars not only for its dynamics and
social changes it triggered, but also for the unique psychological
effects. Medicine of those days was unable to pinpoint the cause
of the disease, and with the philosophy it was using to understand
the pandemic it could have never come to the right conclusion and
effective defense. Philosophical concept of medieval medicine is so
different from current understanding of natural sciences and
human body, that its disconnection from reality is difficult
to comprehend. Medieval institutions faced the horrors of Black
Death with apathy and fatalism, only providing palliative therapy
to themselves and the subjects they were supposed to care for; like
if there was nothing what could have been done to stop the plague.
23
Luebke, David M. n.d. “The Spread of Plague.”

VERONIKA VALDOVA
28
Looking back at the measures described in the Book of Leviticus,
the oldest book on epidemiology and hygiene on record, one has
to wonder how is it possible that these teachings were not used
to combat the disease. Rats and fleas were unclean under this code
and people were not supposed to come in any contact with them.
Medieval teachings considered bathing great threat to human
health, in the difference from the Romans for whom bathing was
not only part of personal hygiene but also an opportunity to
socialize. The Book of Leviticus required the unclean to wash their
bodies and clothes, and burn items which could not be cleaned,
in order to have a living quarters pronounced clean again. Was this
experience completely forgotten? This seems unlikely, because the
Bible was extensively studied by then scholars. Somehow, the
message from the Hebrew Bible either was not passed down or was
not understood during the 13th
century plague epidemic. It may be
difficult to claim with confidence that the rules for isolation
of patients with leprosy and measures against rats and fleas would
have helped to control the pandemic, or at least slow down its
speed. However, the major conditions which were crucial
to uncontrollable spread of this pandemic are easy to identify.
Medieval scholarship after the First renaissance did refer back
to the teachings of ancient philosophers but the understanding of
these texts was not the same as that of ancient Greeks.
Hippocrates’s texts are characteristic by attitude which emphasizes
nature over philosophy and observation over theoretical dogmas
and abstract reasoning. The same applies to Maimonides whose
reasoning was very rational. Medieval medicine diverted from these
principles substantially and put philosophy and complex theoretical
structures first, even when they were in direct contradiction
with observations. Discrepancies were then explained through
sophisticated theories whilst the dogmatic theoretical foundation
was never questioned. As a result of divorce of science from
empirical experience and observation, medieval medicine lacked
capacity to understand biological nature of disease. Christian anti-
Semitism resulted in substantial change in understanding of the
Hebrew Bible, including the Book of Leviticus. If any parts of the
Hebrew Bible were used the focus was on purely theoretical and
dogmatic scholarship rather than practical advice from the Code.

29
During the Middle Ages, it was illegal for all but the Church to own,
study and interpret the Scriptures. Moreover, not all Scriptures
which are included in the Bible today were part of it back then.
Disagreements over canonicity of books such as Hebrew, James,
Peter, and Revelation were settled through Church councils and
papal pronouncements.24
Many Jewish physicians became victims
of anti-Semitic pogroms. One of the most prominent Jewish doctors
who were forced to flee the country in which he lived and practiced
was Moses Maimonides, the author of ten medical works which
included the Oath of Maimonides and the Guide for the
Perplexed25
.
It is not a coincidence that the plague which ravaged Europe in 13th
century followed after expulsion of the only medical practitioners
who had knowledge of the Hebrew Bible which provided at least
some rational guidance. Elimination of free thinkers as bearers
of competing ideologies as a 'threat to the establishment' thus has
causal relationship to the later limitations of the society
with regards to understanding of causes and pathogenesis
of plague. Moses Maimonides in his Guide for the Perplexed, which
was written around 1190 and circulated in Arabic and Hebrew at
time when he and his family already had fled Spain and settled
in Egypt, argued that 'Astrology is no science at all' and therefore
cannot be used as an explanation of origins of a disease. Even
though the work was not accepted as given truth by the whole
Jewish community, its impact was still very significant; and it was
only burnt by the Christian establishment together with some other
'heretical' texts in 1232, three decades after his death. Official
explanation of medieval establishment on cause of the plague
pandemic was that it was the result of 'conjunction of planets'.
Stove-piping, group-think and victimization, persecution, and
elimination of academic, scientific, and religious dissent created an
environment in which people were unwilling and unable to voice
alternative opinions within the Church and Academia even if the
source materials were available. The result was development of a
24
Youell, Greg. 2003. “The Bible and the Catholic Church.” Bible Research.
25
“Torah Class: Rediscovering the Old Testament. Lesson 1, Introduction to
Leviticus Part 1.” 2014. Old Testament Studies. Accessed May 4.

VERONIKA VALDOVA
30
single, dominant, supposedly perfect and ultimately
unchallengeable theory of life. Few people wish to be burned alive
for heresy if the other option is to pursue a good career. Feudal
regimes of medieval Europe created a world in which the
inhabitants lacked all means of defense against the Black Death.
The 1348 plague pandemic
Feudalist economy no longer
recognized some individual rights
(partially reinstituted by Magna
Carta, at least in England)
 loss of autonomy (B)
Y (optional –
either of B
conditions)
Y – inability &
unwillingness to
impose protective
measures at
governance level ^
inability to take
precautions at
individual level
Eleven years into the Hundred
years war (expenses)
 lack of investment in public
infrastructure (hygiene and pest
control) (B)
 increased taxes ^ drop in living
standard (B)
Y (optional –
either of B
conditions)
Attack in Caffa (intentional
spread of infection through large
number of infected corpses
thrown into a seized city)26
Y – a freak
event
N – attack of this
kind occurred only
in Caffa
26
Wheelis, Mark. 2002. “Biological Warfare at the 1346 Siege of Caffa.” Emerg
Infect Dis [serial Online]

31
THE ROLE OF IDEOLOGY
Loss of autonomy of subjects in feudal European states contributed
to the pandemic through total loss of control over quality
of services provided by medical practitioners. Any influence over
this profession was only exercised through the ruler and through
the Church and was not necessarily consistent with the interests
of subjects in their care. Second Renaissance reintroduced ideas
of ancient Greece in their original form. The concept of free will
and human rights was unknown in early medieval Europe,
including British Isles.
FLAWED LIFE SCIENCE DOCTRINE AS THE CAUSE OF
INABILITY TO CONTAIN PLAGUE
Access to information limited to
those with privileged access and ability
to read (ban on possession of the Bible
by all but Church, no access to
scientific texts) (X)
Y – cause and
effect (X)
27
Y – No capacity
to comprehend
nature of the
disease by
elimination of
bearers of
ideas, texts,
and thinking
people.
Essential
knowledge did
already exist on
the subject but
was not used
due to internal
constraints.
Ignoring existing knowledge for
ideological and dogmatic reasons
(anti-Semitism, exclusion of Hebrew
Bible) (X)
Y – cause and
effect (X)
Exclusion of vast segments of
population from education based on
social status
 further limitation of access based on
willingness to comply with official
doctrine  extreme measures taken
against heretics (X)
Y – cause and
effect (X)
27
Cause and effect: causal relationship between measures taken by the
establishment against a “threat” (ideas, texts, and thinking people or people with
certain skills) and their absence in the environment. Employment of measures X(1-
n) causes absence of (means) essential for correct identification of causal
relationships (links between the disease and its causes) and consequently
successful management of the crisis.

VERONIKA VALDOVA
32
Several waves of expulsion of Jewish
scholars and physicians
 elimination of competing
ideologies (X)
Y – cause and
effect (X)
 inability to correctly identify
cause of the disease
Y – critical
condition for
creation of
pandemic 
Spreading of disinformation as the
only “official interpretation” of
religious and philosophical texts
Y – cause and
effect (X)
Enforcing a single “life science”
doctrine across the whole Christian
world
Y – cause and
effect (X)
 Persecution and victimization of
“heretics”, “false prophets” and free
thinkers for acquiring information
from unapproved sources, cogitating
on it, and writing their thoughts
Y – cause and
effect (X)
 Delusion of whole generations of
philosophers and physicians with
regards to (non)existing links between
cause and effect vs. mere association or
no association
28
Y – cause and
effect (X)
All people were subject to the will of Almighty God, the king, and
the clergy. At least in England, this was about to change with the
signature of Magna Carta in 1215 and the creation of British
Parliament in 1237. The Charter was confirmed many more times
during the 13th century; the most significant occasion was in 1297,
when the text was entered on the statute roll, giving it the status
28
Moses Maimonides: The Guide for the Perplexed, 1190. “Astrology is no
science at all” vs. official explanation from 1348 “Plague is caused by conjunction of
planets”

33
of a parliamentary statute. In 1302, a group of 80 landless farm
laborers at Barton upon Humber in north Lincolnshire attempted
to impose a local minimum wage and stop certain restrictive
practices29
. The impact of this Charter probably would have been
much less if it was not for peasant rebellions caused by the Black
Death. The concept of free will and human rights was unknown
in early medieval Europe, including British Isles. All people were
subject to the will of Almighty God, the king, and the clergy.
At least in England, this was about to change with the signature
of Magna Carta in 1215 and the creation of British Parliament
in 1237. The Charter was confirmed many more times during the
13th
century; the most significant occasion was in 1297, when the
text was entered on the statute roll, giving it the status of a
parliamentary statute. The impact of this Charter probably would
have been much less if it was not for peasant rebellions caused
by the Black Death.
At the beginning of the Hundred Years War in 1337, actual
campaigning started when the King invaded France in 1339 and laid
claim to the throne of France. Following a sea victory at Sluys
in 1340, Edward overran Brittany in 1342 and in 1346 he landed
in Normandy, defeating the French King, Philip VI, at the Battle of
Crécy. At time of the plague outbreak in England, in 1948, Edward
III founded the Order of the Garter30
. Eleven years into the
Hundred Years War, in January 1348, the Black Death entered
England. The first wave of Black Death hit Southern England in
1348 and during the following year it swept through Midlands and
Wales to southern parts of Scotland and across the Irish Sea
to Ireland.31
The average death rate was between 30 – 45%.
In winter 1348 plague mutated in its more malignant pneumonic
form, and by 1360 it became gender and age specific. Whilst the
first pestilence of 1348-50 mostly affected adults, the second wave
which ravaged the British Isles in early 1360’s mostly killed young
boys. Another wave which came in 1370’s caused especially high
29
The National Archives. 2014. “Medieval Concept of Human Rights 1215-1500.”
The National Archives.
30
“Edward III (1327-1377).” 2014. The Official Website of the British Monarchy.
31
Ibeji, Mike. 2011. “Black Death.” BBC History.

VERONIKA VALDOVA
34
death rates among children. By 1370’s, the population of England
was halved, and did not start recovering until mid-1500’s. Black
Death pandemic which caused 50 million deaths in 14th
century
Europe resulted in profound social, economic, and cultural change.
Contributing factors to severity of this pandemic were
overpopulation, poor standard of hygiene, close contact between
humans and animals, and shortage of food caused by extended
period of cold weather, now known as the little ice age. The
immediate economic impact of high death toll caused by plague
was profound. Much of land remained deserted; landlords had
difficulties finding tenants and laborers for their holdings. Wages
significantly increased due to shortage of workforce, and many
innovative techniques emerged to compensate for shortage
of people who had to improvise.
Art completely changed form and reflected ubiquitous presence
of death. In response to high death rate among bishops and priests,
the Bishop of Bath and Wells released an appeal that stated:
On the verge of death, if they cannot have a duly ordained priest,
they shall in some way make confession to each other…even to a
layman, or, in default of him, to a woman.
A good death meant reunion with Christ, while a bad death meant
eternal suffering in the fires of hell. The numbers of dead became
so vast that the pope resorted to consecrating the Rhone River;
in which the bodies were interred32
. Probably the most widely
accepted theory about the origin of plague of the time was the one
released on October 6, 1348, by the medical faculty at the University
of Paris, one of the most respected institutions of that time. The
statement was released upon the request of Philip VI, king
of France. The report explained the plague as a result
of conjunction of planets and cited authorities such as Hippocrates,
Ptolemy, Albertus Magnus, and Artistotle:
The distant and first cause of this pestilence was and is a certain
configuration in the heavens. In the year of our Lord 1345…there
was a major conjunction of three higher planets in Aquarius.
32
Des Ormeaux, AL. 2007. “The Black Death and Its Effect on Fourteen and
Fifteen Century Art.” Graduate Faculty of the Louisiana State University and
Agricultural and Mechanical College.

35
Indeed, this conjunction…being the present cause of the ruinous
corruption of the air that is all around us, is a harbinger
of mortality and famine.
We believe that the present epidemic or plague originated from
air that was corrupt in its substance…air, which is pure and
clear by nature, does not putrefy or become corrupt unless it is
mixed up with something else, that is, with evil vapors…[which]
have come about through the configurations [of the planets], the
aforesaid universal and distant cause. (Ibid)
This is exactly the type of explanation which was once condemned
by Maimonides in his Guide for the Perplexed, a medical and
philosophical text which was among those burned a century ago.
At the time of Black Death epidemic, very little was known about
the disease itself and there was no cure. The teachings of Ancient
Greece could not be used in their original form because of fear
of being expelled from Church for heresy. Hippocratic medicine,
based on keen observation and detailed knowledge of human
anatomy and physiology, would likely be able to cope with the
epidemic better through reliance on logic and common sense.
Medical treatment recommended for buboes was to open them
to let the infection out of the body. Muslim physician and poet Abu
Khatima who practiced in Granada advised cutting only mature
abscesses to make sure the patient does not bleed to death.
In medieval times, surgery was sharply divided from internal
medicine and counted as a menial job, and was not even taught
at universities as part of medical curriculum. Surgeons on the other
hand were more likely to have some training in medical theory.
Barbersurgeons were trained through apprenticeship and had no
training on theory. The role of apothecaries was to mix the
medicines as directed by physicians.
Apart from the main categories, there were also non-registered
unlicensed practitioners, such as midwives, who namely cared
about the poor. Whilst surgery was left to surgeons, internal
medicine in medieval times was often practiced by monks who
were the only scholars with wide access to medical literature. Not
all medieval physicians were university educated. Those who were

VERONIKA VALDOVA
36
consistently favored ancient teachings over experience.
Humoralism, the predominant medieval medical theory, taught
that the four bodily humors, black bile, yellow bile, blood, and
phlegm, were affected by a person's diet, activity, and environment.
One of the measures taken against plague by the populace were so
called 'bowdy badges' – highly provocative items made of animal
genitalia which were supposed to protect people against plague33
.
Old theories and medical teachings were helpless in face of the
magnitude of devastation by the Black Death. Practitioners and
surgeons, instead of blindly following official theories, became
creative and relied on their own experience and judgment34
. Matza
in his thesis 'The sacred nature of secular medicine in the time of
the Black Death' explains that medieval scholastic medicine was
founded upon highly rationalized framework of nature and health,
but simultaneously recognized divine agency as the logical cause
and cure of human illness35
.
Relatively sudden disappearance of medical knowledge together
with especially Jewish practitioners of medicine and surgery
is linked to the concerted effort of newly asserted feudal rulers who
were using Christian Church as a convenient oppressive method
in order to keep the population in submission without having to
use too much force which was sorely needed elsewhere for never
ending crusades. Competing ideologies and philosophies were
eliminated through burning of texts and expulsion of their
proponents. Many Jewish physicians fled Europe because of anti-
Semitic pogroms and took their Hebrew Bible and rabbinic
scriptures with them. But expulsion of scholars would not be
enough to stop people from thinking, no matter how limited their
access to knowledge was.
33
Gimbel, LM. 2012. “Bawdy Badges and the Black Death: Late Medieval
Apotropaic Devices against the Spread of the Plague”. A Thesis submitted to the
Faculty of the College of Arts and Sciences of the University of Louisville.
34
Vanneste, SF. 2010. “The Black Death and the Future of Medicine”. Wayne
State University.
35
Matza, Louis. 2012. “The Sacred Nature of Secular Medicine in the Time of
the Black Death”. New Brunswick, New Jersey: Rutgers University.

37
Early medieval quest for heretics affected the most people who
were not only intelligent, literate and well-read, but also outspoken
and capable of formulating and communicating an independent
judgment. People like that are extremely dangerous for any
authoritarian regime because of their unpredictability, resilience to
external pressures, intellectual independence, and constant quest
for knowledge. This combination of traits in individuals, especially
if combined with insensitivity to lack of approval by the community
makes despots uncomfortable because of the potential for
challenging the ruler’s claim to power.
The psychology of medieval people was, however, very different.
Rather than on physicians, they had to rely on religious explanation
of the disaster which struck them. No treatment was offered
to those who were affected by the disease; and the only advice
provided to them was to turn to God. Authorities such as the
Church, the ruler, and medicine, were failing in the face of Black
Death, and people were largely left to their own devices. Some
cities attempted to impose preventative measures, of which the
most rational was a ring of fire which would protect certain areas
from spreading of the disease.
Unity of State and Church did not allow the academic community
to question religious dogmas. Medieval people were obsessed with
their fate after death even before the plague, and during the
outbreak even more so. Des Ormeaux pays lot of attention to the
reaction of people to the pandemic, and the spread of terror and
fear, and the desire to keep themselves alive. Paradoxically, milder
outbreaks of plague in later years provoked more intense emotional
reaction than the initial strike because certain psychological
defenses apparently did not get activated and people were less
likely to cope with the overwhelming presence of death through
complete blocking of these memories. Ritual mass murders of Jews
were common. As perceived culprits of the disease they were
frequently used as scapegoats36
.
36
Des Ormeaux, AL. 2007. “The Black Death and Its Effect on Fourteen and
Fifteen Century Art.” Graduate Faculty of the Louisiana State University and
Agricultural and Mechanical College.

VERONIKA VALDOVA
38
The effects of authoritarian regimes on distribution of intellect in
population are largely uncertain. From policy documents and
historical records it is apparent that despots tend to systematically
eliminate free thinkers and intellectual elite. How these measures
affect the general population is subject to discussion because
heritability (probability that a certain trait will be inherited)
of psychometric, personal character, and intelligence traits is not
only dependent on genetics but also on gene expression and
environment. Manifestation of a trait tells us little about the
genotype. While normal distribution of intelligence in population
around the world is a factor studied by many researchers for its
correlation to living standard and wealth, distribution
of personality types around the globe is studied much less. There is
no reason to assume that distribution of standardized personality
types in population shall be more or less even. What the frequency
does reveal is which types have been more successful throughout
human existence. Myer-Briggs personality test describes four basic
personality characteristics which depending on level of expression
of the respective trait describe sixteen main personality types. The
main measured characteristics are inclination toward introversion
or extroversion, sensing or intuition, feeling or thinking, and
judging vs. perception as characteristics of processing information
and decision-making style. While distribution of some traits
in population is more or less even, there is a striking disproportion
in number of those who process information through sensing
rather than intuition. Sensing types (ISFJ, ESFJ, and ISTJ) are also
the most frequent personality types whilst N-J types (INFJ, ENFJ,
INTJ, and ENTJ) are rarer. People who rely on their senses pay
attention to physical reality and direct experience, whilst those who
rely on intuition tend to systematically search for patterns and
meaning of the information they are getting.
Intellectual capacity to correctly identify patterns may well be the
cause why intuitive thinkers are consistently perceived
by authoritarian regimes as threat. Current intelligence analysts
employ sophisticated methods for identification of indicators

39
of intent37
. For dictators the distinction between capabilities and
intentions is irrelevant; and mental capacity to process information
in a structured manner counts as a well-defined threat regardless
intent. In an authoritarian regime or oppressive theocracy an
outspoken free thinker would be very unlikely to survive very long.
Medieval medicine was unable to do much for those who
contracted plague; and only resorted to palliative care and spiritual
assistance. The profession as whole completely resigned
on combating the disease and succumbed to fatalism which
engulfed Europe with the spread of plague. Astonishingly, fear
of heresy was stronger than fear of plague; and scriptures which
would have been helpful in combating the pandemic were not dug
out from the archives and monasteries. Medicine of Dark Ages
brought nothing to future generations of physicians in terms
of knowledge. Did the millions of casualties of plague bring
anything positive to medicine? The answer is – nothing at all.
37
Cragin, Kim, and Sara A Daly. 2004. “The Dynamic Terrorist Threat - An
Assessment of Group Motivations and Capabilities in a Changing World.” RAND
Prepared for the United States Air Force.

40
III. MEDICAL OATHS
Medical profession is special because of the power a physician gains
over human body due to his or her knowledge of its functions, and
due to vast arsenal of means of affecting these bodily processes.
Physicians are present at birth, and often also at the very moment
of death. They often spend more time with the patient during his final
moments than the family. Physicians are well aware of the power
they have got over 'ordinary' people. The profession recognizes that
there is a need for formal adherence to a set of values. This is
achieved through an oath which is taken after graduation. Medical
professionals all over the globe take an oath that they will fulfill the
profession to the best of their ability and to the benefit of the patient.
Unsurprisingly, the cradle of western civilization and continental
legal system, ancient Greece, became the place where famous
physician Hippocrates formulated the first oath for practitioners
of this noble profession. This ancient oath, considered outdated by
many, and only very rarely used without modifications, still serves as
the most important ethical professional code in medicine.
Hippocrates is rightly considered the father of modern western
medicine. His teachings were based on empirical experience and
careful observation. This principle is the core of modern medicine
which is based on meticulous research and orientation towards the
patient rather than interests of the doctor.

41
THE CODE OF HAMMURABI
The Code of Hammurabi consisted of 282 laws which were carved
in stone around 1750 BC during the reign of Babylonian king
Hammurabi (1792 – 1750 BC). The code covered wide range
of matters from public to private: marriage and family relations;
negligence; fraud; commercial contracts and fairness in commercial
exchanges; duties of public officials; property and inheritance;
crimes and punishments; techniques of legal procedures; protection
for women, children, and slaves; protection of property; standard
procedures for adjudicating disputes; debt relief for victims of food
shortages and drought; and also guidelines for physicians and
surgeons. Penalties imposed by the code varied according to the
status of the victim which could be either patrician, plebeian, or a
slave. Patricians, the highest class, were allowed to retaliate against
the perpetrator following the spirit of the Old Testament – eye
for eye and tooth for tooth. On the other hand, the lower classes
were only entitled to monetary compensation. In regards
to medicine, the code regulated malpractice and compensation
for successful surgery or treatment, and penalties for any
unsuccessful therapeutic procedures.38
The Hammurabi code
expected the physician or surgeon to treat only patients who could
be cured, and imposed penalties for unsuccessful treatment
attempts. The same applied to veterinarians. This code excluded
any experimentation by default because any innovation inevitably
would result in unsuccessful novel treatment attempts in some
patients.
215. If a surgeon has operated with the bronze lancet on a patrician
for a serious injury, and has cured him, or has removed with a
bronze lancet a cataract for a patrician, and has cured his eye, he
shall take ten shekels of silver.
216. If it be a plebeian, he shall take five shekels of silver.
217. If it be a man's slave, the owner of the slave shall give two
shekels of silver to the surgeon.
38
Sandlow, LJ. 2012. “Oaths, Codes, and Charters in Medicine over the Ages.”
Hektoen International – A Journal of Medical Humanities 3 (3).

VERONIKA VALDOVA
42
218. If a surgeon has operated with the bronze lancet on a patrician
for a serious injury, and has caused his death, or has removed a
cataract for a patrician, with the bronze lancet, and has made him
lose his eye, his hands shall be cut off.
219. If the surgeon has treated a serious injury of a plebeian's slave,
with the bronze lancet, and has caused his death, he shall render
slave for slave.
220. If he has removed a cataract with the bronze lancet, and made
the slave lose his eye, he shall pay half his value.
221. If a surgeon has cured the limb of a patrician, or has doctored a
diseased bowel, the patient shall pay five shekels of silver to the
surgeon.
222. If he be a plebeian, he shall pay three shekels of silver.
223. If he be a man's slave, the owner of the slave shall give two
shekels of silver to the doctor.
224. If a veterinary surgeon has treated an ox, or an ass, for a severe
injury, and cured it, the owner of the ox, or the ass, shall pay the
surgeon one-sixth of a shekel of silver, as his fee.
225. If he has treated an ox, or an ass, for a severe injury, and
caused it to die, he shall pay one-quarter of its value to the owner
of the ox, or the ass.39 40 41
39
Hammurabi, and King LW (translator). “The Code of Hammurabi.”
40
Rev. Claude Hermann Walter Johns. 1910. “The Eleventh Edition of the
Encyclopaedia Britannica.”
41
C. H. W. Johns. 2014. “The Avalon Project. Source: Babylonian and Assyrian
Laws, Contracts and Letters, (1904), One of a Series Called the Library of Ancient
Inscriptions, from a Facsimile Produced by The Legal Classics Library, Division of
Gryphon Editions, New York in 1987.”

43
THE VADAYA'S OATH
Hindu Physician’s Oath (15th
century BC) which was also known as
the Vaidya’s Oath extended physician’s responsibilities to his
lifestyle. Hindu physicians were not allowed to eat meat, drink
alcoholic beverages, or commit adultery. Their conduct was
supposed to be altruistic and free from earthly desires. This is
probably also the only medical oath which expects the physician to
treat all patients whom he meets on his errands including those
who cannot afford to pay for his services.

VERONIKA VALDOVA
44
HINDU PHYSICIAN’S OATH
You must put behind you desire, anger, greed, folly, pride, egotism,
jealousy, harshness, calumny, falsehood, sloth and improper
conduct.
With short-cut nails, ritually clean and clad in the orange garment,
you must be pledged to truth, and full of reverence in addressing
me...
If, however, you behave perfectly, while I profess false views, I shall
be guilty of sin and my knowledge shall bear me no fruit.
(After having finished your studies) with your medicaments you
shall assist Brahmins, venerable persons, poor people, women,
ascetics, pious people seeking your assistance, widows and orphans
and any one you meet on your errands, as if they were your own
relatives. This will be right conduct.42
42
Sandlow, LJ. 2012. “Oaths, Codes, and Charters in Medicine over the Ages.”
Hektoen International – A Journal of Medical Humanities 3 (3).

45
THE HIPPOCRATIC OATH
I swear by Apollo Physician and Asclepios and Hygeia and Panacea
and all the gods and goddesses, making them my witnesses, that I
will fulfill according to my ability and judgment this oath and this
covenant: To hold him who has taught me this art as equal to my
parents and to live my life in partnership with him, and if he is in
need of money to give him a share of mine, and to regard his
offspring as equal to my brothers in male lineage and to teach them
this art — if they desire to learn it — without fee and covenant;
to give a share of precepts and oral instruction and all the other
learning to my sons and to the sons of him who has instructed me
and to pupils who have signed the covenant and have taken an oath
according to the medical law, but no one else.
The reference to polytheist Greek Gods was probably the reason
why Hippocratic Oath43
was forgotten during the Middle Ages and
was only brought to light in early 1500s. Apollo, Asclepius, Hygeia,
and Panacea, were replaced by a single God or anything what the
concerned school held sacred. The selection of Gods reflects
patrons of medical profession: Apollo was the healer and had power
over plague; Asclepius, a son of Apollo rescued from his dead
mother’s womb, was instructed in the art of medicine by a centaur,
and became recognized as the god of the medical art; Hygeia and
Panacea, the daughters of Asclepius, were known as the goddess
of good health and goddess of all cures. The reference to Gods is a
reflection of respect to teachers and patrons rather than Supreme
justice, which is as per the last paragraph taken care of by the
patients and other medical professionals themselves. The
profession was traditionally hereditary and handed down
from father to son, a practice which is not unusual even today. This
paragraph suggests that Medical Oath was in fact part of the law
in ancient Greece, and was legally required for practitioners
of medicine, something like a Pledge of Allegiance upon entering
public service. These days, medical oath is still sworn during
graduation ceremony at most medical schools, but does not have its
43
Hippocrates, and Ludwig Edelstein (Translation, interpretation). 1943. “From
The Hippocratic Oath”. Baltimore: Johns Hopkins Press.

VERONIKA VALDOVA
46
legally binding meaning as it used to have. Access to information
on the art of medicine, which can potentially cause harm if used
inappropriately, was restricted to those who have taken the oath.
In addition, the oath was taken and signed by students when
commencing medical school and not upon completion of their
studies. In ancient Greece, the meaning of medical oath was far less
symbolic than it is now. It was a legal act. Today, medical
profession is subject to regulations which to a certain degree
replace the need for formal recognition of an ethical code. In 1928,
only one fifth of medical schools in the United States let their
students take an oath upon graduation. The situation changed
dramatically after the Second World War as a result of the
Nuremberg trials and introduction of the Nuremberg Code. Oath is
now an integral part of graduation ceremonies at vast majority
of schools all over the globe. Most schools use some type
of modification to keep the oath up to date and consistent
with modern values, but the spirit of Hippocrates’s determination
to have the benefit of the patient in mind at all times has not
changed, not even after 2400 years.
I will apply dietetic measures for the benefit of the sick according
to my ability and judgment; I will keep them from harm and
injustice.
The first remedy an ancient physician would consider is
modification of patient’s diet and lifestyle. Some authors reject the
concept of Hippocratic medicine as paternalistic. It certainly does
not seem to be the case with prescription of a diet because it is very
hard to imagine a patient who would comply with a dietary
regimen against his or her will. With lifestyle modification, trust
between physician and patient is essential, just like the
practitioner’s authority.
I will neither give a deadly drug to anybody who asked for it, nor
will I make a suggestion to this effect. Similarly I will not give to a
woman an abortive remedy. In purity and holiness I will guard my
life and my art.
This part is often removed completely from the oath. Ban
on euthanasia or assisted suicide is ingrained in the ancient code

47
of medical ethics, just like the ban on abortions. The statement
on not giving a deadly drug to “those who ask for it” does not
necessarily mean the patient but anyone who might use it for other
purpose than to benefit the patient. A pharmacist today would not
be allowed to give a poison to whoever asks for it because this
ancient principle present in the Hippocratic Oath was directly
incorporated in law. Indian revised medical oath drafted by Dr.
Rebello44
in 2003 specifically mentions ban on administration
of deadly drugs and harmful procedures:
I shall NOT prescribe lethal drugs, like anti-retrovirals,
chemotherapy, or give electro-convulsive therapy to my patients.
Modern Medical Oath available at the Indian Medical Association is
not specific about administration of certain drugs and refers to the
Indian Medical Council (Professional Conduct, Etiquette and
Ethics) Regulations 200245
.
I will not use the knife, not even on sufferers from stone, but will
withdraw in favor of such men as are engaged in this work.
When taken to a more abstract level, this principle is still valid
today, as it reflects specialization in medicine and sharp division
between internal medicine and surgery. General practitioners are
only allowed to treat patients whose diseases do not require more
specialized care, and are not supposed to perform surgical
procedures they are not sufficiently trained in.
Whatever houses I may visit, I will come for the benefit of the sick,
remaining free of all intentional injustice, of all mischief, and
in particular of sexual relations with both female and male persons,
be they free or slaves.
Ban on sexual relationships with patients is still present in some
cultures whilst left out from the Oath in others. In more general
44
Rebello, L. 2004. “Revised Doctors Oath. Independent Media Center India”.
Independent Media Center.
45
“Modern Oath.” Indian Medical Association.

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